Daily Self-Check

Please complete this each day prior to proceeding to the theatre.

Name
Do you have any of the following new or worsening symptoms?(Required)
Symptoms should not be chronic or related to other known causes or conditions, including recent vaccination.
  • Fever and/or chills
  • Difficulty breathing or shortness of breath
  • Cough
  • Sore throat, trouble swallowing
  • Runny nose/stuffy nose or nasal congestion
  • Decrease or loss of smell or taste
  • Nausea, vomiting, diarhea, abdominal pain
  • Not feeling well, extreme tiredness, sore muscles
  • Pink Eye (Conjunctivitis)
  • Headache (unusual, long-lasting)
Do you have any of the above symptoms that are NEW or WORSENING?
In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per the federal quarantine requirements?(Required)
Have you had close contact with a confirmed or probable case of COVID-19?(Required)
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?(Required)
This field is for validation purposes and should be left unchanged.